OC Spectrum Disorders

Body Dysmorphic Disorder (BDD)

BDD is a morbid intensification of the normal minor worries about the body which are common in adolescence or early adulthood. Technically, BDD is a preoccupation with a nonexistent, or minimal defect in appearance that generates significant distress or impairment in social, occupational and/or other important areas of life; and involves unrealistic beliefs in other people’s reaction to this ‘ugliness’. People with BDD put a very large emphasis on their appearance and believe that other people evaluate them negatively solely on the basis of this appearance.

There are differences between Obsessive Compulsive thinking and BDD thinking. The BDD thinker may view the thoughts as relevant to his or her personality and beliefs; and, although severe and debilitating, a ‘normalish’ part of life. The OC thinker on the other hand will invariably view the thoughts as intrusive and alien, nothing to do with his or her perceived once ‘true’ personality.

The OC thinker will also use ‘curing’ thoughts such as counting, thinking ‘good things’ etc. that are relevant to him or her but probably have little connection with the intrusive thought or thoughts that they are used to counter. The BDD thinker will invariably be focused on the perceived abnormality and all thoughts will surround this area and be totally relevant (to the sufferer at least) to the cause of preventing the abnormality being seen. Another difference between OC and BDD thinking is that the OC thinkers ‘curing’ thoughts and rituals are used to reduce anxiety, while the BDD thinker’s thoughts are not used in that way at all.

Trichotillomania (TTM)

TTM involves the recurrent pulling out of one’s hair, resulting in noticeable hair loss. In general, it is said that the TTM sufferer experiences tension prior to pulling, and tension if he or she tries to resist the act; and then some form of relief or pleasure once the pulling is completed. It is not thought that there is any pleasure involved in the pain experienced during the act – in fact many TTM sufferers state that they do not experience pain when pulling.

Current opinion seems to be that TTM is not a form of Obsessive/compulsive Disorder (OCD) as has been assumed for some time, but is an Impulse Control Disorder. This type of disorder is defined by the irresistible tension that is released by performing the act. Some forms of OCD could also be grouped here. However, some TTM sufferers do not seem to experience this irresistible tension, but still have the problem. A minority of TTM sufferers also appear to suffer from OCD, and a majority also suffer from depression and/or an anxiety disorder. For TTM to be classified as a disorder there has to be considerable distress involved and a reduction in everyday functioning.